gms | German Medical Science

Joint German Congress of Orthopaedics and Trauma Surgery

02. - 06.10.2006, Berlin

Article

Send article

Surgical treatment of congenital iliac dislocation of the hip with two-stage progressive lowering and total hip replacement

Meeting Abstract

Search Medline for

  • R. Binazzi - Dept. of Orthopaedic Surgery, Istituto Ortopedico Rizzoli, Bologna, Italy
  • A. Bondi - Dept. of Orthopaedic Surgery, Istituto Ortopedico Rizzoli, Bologna, Italy
  • A. Manca - Dept. of Orthopaedic Surgery, Istituto Ortopedico Rizzoli, Bologna, Italy
  • P.G. Marchetti - Dept. of Orthopaedic Surgery, Istituto Ortopedico Rizzoli, Bologna, Italy

Deutscher Kongress für Orthopädie und Unfallchirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 92. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie und 47. Tagung des Berufsverbandes der Fachärzte für Orthopädie. Berlin, 02.-06.10.2006. Düsseldorf, Köln: German Medical Science; 2006. DocW.4.2.6-1228

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgu2006/06dgu0631.shtml

Published: September 28, 2006

© 2006 Binazzi et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Congenital Iliac dislocation of the Hip (CROWE Grade IV) is a very rare condition. In these cases, Total Hip Replacement can be technically very difficult. In the last 20 years, in dysplastic cases we have used the following protocol: 1) in CROWE Grade I and II we perform a single-stage Total Hip Replacement in a routine manner; 2) in CROWE Grade III we perform a single-stage operation with intra-operative “wake-up” test to control Sciatic Nerve function; 3) in CROWE Grade IV we use an original two-stage procedure with progressive lowering of femoral epiphysis followed by Total Hip Replacement.

The first stage consists in a fascio-mio-arthrolysis (Adductor’s tenotomy, gluteal fasciotomy, Psoas’ Z-lengthening, capsulectomy, femoral head resection) and application of an External Fixator (3 pins in the Ileus and 3 in the Femur). Then we start a progressive lowering of the femoral epiphysis (about 1.5-2 mm/day) until the femoral neck is in front of the Paleo-acetabulum (usually after 2-3 weeks) allowing a correct placement of the cup into the rotation center.

This is a retrospective study about 14 cases (9 females and 4 males, 1 bilateral) of this technique. The average limb lengthening was 6.1 cm. In all cases the cup was placed in the paleo-acetabulum and we have always used a straight, cementless, conical stem (in order to correct neck anteversion and to better fit into the straight femoral canal). Excellent and Good results were 78.5%. No major complications were observed: in particular in no case we had infections of the pins. We had a case of cup aseptic loosening at two years requiring revision with a reinforcement ring and a cemented PE liner.

  • The main surgical problem is the cup placement, for the severe hypoplasia of all walls and for the poor bone quality;
  • The cup should always be implanted into the Paleo-acetabulum, both for Biomechanical and for cosmetic reasons (no or minimal leg length discrepancy)
  • Medialising the cup is very important in order to improve the Glutei lever arm. Care has to be taken not to perforate the Lamina Quadrilatera;
  • Lateral grafting according to Harris is necessary only if more than 30% of the cup is uncovered;
  • Usually there is no problem with the femoral component (straight to correct neck anteversion);
  • CDH patients are young and they need bearing surfaces alternative to PE. We always used ceramic-on-ceramic or metal-on-metal.

Therapeutic study, Level IV.